Lisset Palmero, $63M Medicare Fraud, Florida 2011

Miami Woman Sentenced to 68 Months in Prison for $63M Medicare Scam

A former office manager at a defunct health care provider has been sentenced to 68 months in prison for her role in a massive Medicare and Medicaid fraud scheme that resulted in over $63 million in false claims.

Lisset Palmero, 45, of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to her prison term, Palmero was sentenced to three years of supervised release and ordered to pay restitution in the amount of $17.4 million.

Palmero was employed as a receptionist and office manager at Health Care Solutions Network Inc. (HCSN), a mental health facility that purported to provide Partial Hospitalization Program (PHP) services. A PHP is a form of intensive treatment for severe mental illness.

Court documents reveal that Palmero was aware that her employer paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid.

Palmero also knew that many of the ALF referral patients were ineligible for PHP services because they suffered from mental retardation, dementia or Alzheimer’s disease. She was also aware that HCSN personnel fabricated patient medical records, many of which were created weeks or months after the patients were admitted to HCSN for purported PHP treatment.

During her employment at HCSN, Palmero actively concealed the fabrication of medical records by preparing and causing others to prepare documentation that was later used to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Florida Medicaid.

The scheme resulted in HCSN billing Medicare and the Florida Medicaid program approximately $63 million for purported mental health services from 2004 through 2011. The case is being investigated by the FBI and the U.S. Department of Health and Human Services Office of Inspector General and was brought as part of the Medicare Fraud Strike Force.

The Medicare Fraud Strike Force, operating in nine cities across the country, has charged over 1,500 defendants who have collectively billed the Medicare program for over $5 billion since its inception in March 2007.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), visit www.stopmedicarefraud.gov.

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